Provider Demographics
NPI:1356033203
Name:PIASECZNA, ANNA AGNIESZKA (FNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:AGNIESZKA
Last Name:PIASECZNA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:AGNIESZKA
Other - Last Name:PIASECZNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2603 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2325
Mailing Address - Country:US
Mailing Address - Phone:818-703-3122
Mailing Address - Fax:
Practice Address - Street 1:201 S BUENA VISTA ST STE 420
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4571
Practice Address - Country:US
Practice Address - Phone:818-238-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95210440163WS0121X
CANP95025338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery